Abdominal Surgery and Laparoscopy - There are many indications for open abdominal surgery or minimally invasive (laparoscopic) surgery. Common indications for open abdominal surgery include:

*removal of gastrointestinal foreign bodies or masses

*splenectomy

*liver lobectomy (removal of all or part of a liver lobe)

*biopsy of multiple internal organs

*removal of stones of the urinary system that cannot be removed with minimally invasive techniques

*correction of gastric dilatation-volvulus (GDV)

Some procedures can be performed with laparoscopy. Laparoscopic procedures are minimally invasive as they are performed through two or three small (5-10 mm) incisions rather than one large one. Procedures that we are currently performing with laparoscopy include:

The details of each procedure and aftercare are discussed at the time of your consultation.

Prosthodontics -

Minimally Invasive Surgery - In recent years, minimally invasive approaches to surgery have gained popularity in veterinary medicine. Minimally invasive surgery is very common in human medicine, and developments in the veterinary world have allowed these techniques to be utilized in both small and large animals.

Laparoscopy involves the placement of a port, usually 5 mm in diameter, into the abdomen to allow insertion of a camera (laparoscope). The camera is used to visualize the contents of the abdominal cavity. Typically, one or two additional ports are placed to allow insertion of instruments, such as a probe or biopsy forceps. These ports are even smaller than the initial port. Through laparoscopy, we can now spay dogs, perform prophylactic gastropexies, take liver biopsies, and remove retained intra-abdominal testicles (cryptorchid testicles).

Ovariohysterectomy or ovariectomy (spay procedures) are performed in large dogs to decrease the size of incisions and therefore decrease morbidity associated with surgery. In some male dogs, testicles are retained in the abdomen and do not descend normally into the scrotum. In these dogs, laparoscopy can be used to remove the retained testicle so that a larger incision into the abdomen does not have to be made. Laparoscopy also enhances visualization of the testicle to reduce the chance of complications.

Prophylactic gastropexies are often performed in large breed dogs at the same time as a laparoscopic spay or as the sole procedure. Gastropexy is performed in large breed, deep-chested dogs as they are prone to gastric-dilatation and volvulus (GDV). GDV is a life threatening condition that most often happens to middle aged dogs, in which the stomach rotates on itself. Prophylactic gastropexies prevent GDV by creating an adhesion between the body wall and the stomach wall. Prophylactic gastropexy performed in the traditional ‘open’ manner involves a large incision, whereas a gastropexy performed using laparoscopy only results in 2 small incisions.

Many animals suffer from liver disease, and frequently a specific diagnosis cannot be attained until a liver biopsy is performed. As with gastropexy, liver biopsy in the traditional manner involves a large incision to expose the organ for biopsy. Using laparoscopy however, the liver can be visualized and samples can be taken for biopsy and other tests to obtain a specific diagnosis.

Documented advantages of laparoscopy in people include decreased pain, hospitalization, faster return to function, improved cosmesis, lower infection rates, and improved visualization and magnification. In veterinary medicine, multiple studies found that dogs that were spayed laparoscopically were less painful than those spayed in the traditional open method.

PCCL….

Arthroscopy is the exploration of a joint using a camera (arthroscope). Arthroscopy in small animal surgery is most commonly used to explore the shoulder, elbow, and stifle (knee). Arthroscopy can be used to diagnose and treat several disease of these joint such as osteochondritis dessicans (OCD), medial compartment disease of the elbow, and cruciate disease and meniscal tears of the knee. Arthroscopy avoids the use of a larger incision into the joint by allowing evaluation and treatment through multiple smaller port incisions. This results in less pain and faster return to function.

Culp W. The effect of laparoscopic versus open ovariectomy on post-surgical activity in small dogs. Vet Surg 2009.

Percutaneous Cystolithotomy - A small incision is made over the apex of the bladder with the patient under anesthesia. The small portion of the bladder is brought into the incision and sutures are used to hold it in place. A stab incision is made into the bladder and a threaded cannula is placed into the lumen of the bladder. A cystoscope is placed into the bladder for inspection and bladder stone removal.The advantage of this technique is a very small incision which means less pain for the pet. The interior of the bladder is better visualized than with conventional surgery because of magnification and better illumination. In adddition, the scope is passed from the apex of the bladder toward the urethra along it's axis. The surgeon cannot see the interior of the bladder as effectively as the cystoscope. This is usually and outpatient procedure

Dentistry

Oral surgery - Oral surgery is performed on cats and dogs with diseases and injuries of the mouth. Procedures are performed most often after xrays are taken of the structures involved. Oral surgery includes procedures such as biopsy of abnormal tissues, fracture repair, removal of tumors of the upper or lower jaw, gums or tongue.

Periodontal Therapy - Periodontal therapy focuses on the treatment of suprabony and infrabony pocket resulting in a diseased periodontium. The periodontium consists of the gingiva (free and attached), alveolar bone, periodontal ligament and cementum. The periodontal therapies provided are:1.) Closed and open root planing: root planing or "deep cleaning" is the removal of calculus from the root surface. In conjunction with root planing is subgingival curettage; the removal of the diseased soft tissue from pocket. Closed root planing is performed on infrabony pockets less than 5 mm in depth. Closed root planing does not require a gingival flap to visualize the calculus on the root surface. Open root planing is performed on periodontal pockets 5mm and deeper. A gingival flap is raised to allow visualization of the root surface enabling complete removal of all calculus from the root surface. 2.) Bone augmentation: an osteoconductive material is placed in an infrabony pocket following open root planing.3.) Multiple, complete or complicated extractions: multiple extraction and complete extractions may be required in cases of advanced periodontal disease in order to achieve oral health. Complicated extractions are those that require special care when extracting the tooth. For example with advanced alveolar bone loss in the region of the mandibular first molar in small breeds. Extraction may be challenging due to the potential for fracturing the jaw. 4.) Oronasal fistula repair: A mucoperiosteal flap is utilized to close the palatal defect.5.) Gingivectomy: gingivectomy or removal of gingival tissue is typically performed when gingival hyperplasia is present creating a suprabony pocket.

Following the treatment of advanced periodontal disease close radiographic monitoring and professional cleaning will be required until it has been determined to be stable. Once the disease has been stabilized professional oral health is returned to the referring veterinarian.

Orthodontics - Orthodontics, formerly orthodontia (from Greek orthos "straight or proper or perfect"; and odous "tooth") is the first specialty of dentistry that is concerned with the study and treatment of malocclusions (improper bites), which may be a result of tooth irregularity, disproportionate jaw relationships, or both. Orthodontic treatment can focus on dental displacement only, or can deal with the control and modification of facial growth. Various devices such as braces are employed in veterinary patients to improve oral function.

Restorative Dentistry - Crown application is most commonly performed by veterinary dentists. At AVS, this work is very commonly done on police working dogs who need good dental function to perform their duties. Dr. Robert Ulbricht works with police departments from all over the St. Louis metropolitan area, southern Illinois and even Kentucky.

1.) Root canal therapy involves the complete removal of pulp tissue (complete pulpectomy). Indications for root canal therapy include crown fractures that result in pulp exposure (complicated crown fractures), discolored teeth (pink, purple, blue, gray or dark beige), and asymmetrical canals (visible only on radiographs). Root canal therapy may be performed through the crown (standard root canal therapy) or when necessary may be achieved by accessing the root tip (surgical root canal therapy). Indications for a surgical root canal include apical lysis and failure of standard root canal therapy after multiple attempts.

2.) Vital pulp therapy may be performed on acutely fractured teeth (less than 24 hours in patients older than 12 months) or following a partial crown amputation to shorten the crown height. Shortening crown height is typically performed when a traumatic malocclusion is present (teeth traumatizing hard or soft tissue) or in special circumstances for disarming the patient. Vital pulp therapy is the removal of coronal pulp tissue followed by the placement of a medicament and the restoration material.

Internal Medicine

Blood pressure determination and monitoring - The blood pressure in dogs and cats is measured differently than in humans. AVS uses the doppler method which is the most accurate with pets that are awake. While under anesthesia the pressure is measured continuously, electronically.Pets can have disorders that cause the blood pressure to be either too high or too low. In St. Louis, Associated Veterinary Specialists have internal medicine specialists who are the most experienced in treatment of disorders of blood pressure.

Bone marrow aspiration and biopsy - Cats and dogs suffer from many bone marrow disorders. An anemic pet may have pale gums or tire out easily. Pets with low white blood cells might develop infections or fevers. Pets with low platelets may have spontaneous bleeding. Complete blood counts are done to determine blood cell levels. After preliminary evaluation a "bone marrow" may be necessary. A bone marrow can be done with local anesthetic or general depending on the pet. An "aspirate" as well as a biopsy are taken. AVS uses a sophisticated system to take these biopsies that minimizes the amount of time the pet has to be under anesthesia.

Bronchoscopy - Bronchoscopy is an endoscopy procedure where a bronchoscope is used to evaluate the larynx, trachea and bronchi. It is performed under light anesthesia.Bronchoscopy has many indications. These include evaluation of coughing, removal of foreign bodies, evaluation of tracheal collapse and placement of stents for that condition. Bronchoscopy is used for evaluation of unexplained abnormal breathing or voice changes; and evaluation of lung abnormalities seen on xrays. Bronchoscopy allows visualization of the airways for abnormal conditions as well of performance of bronchoalveolar lavage which facilitates culture and cytology of the airways.Associated Veterinary Specialists uses a videobronchoscopy system that allows for both photography of the airways as well as video recordings.

Colonoscopy - Colonoscopy is endoscopic examination of the rectum, colon and cecum. On occasion it is possible to examine the ileum as well. Pets with diseases of the colon often have diarrhea with fresh blood, mucus, straining to defecate and urgency to defecate. They often pass frequent, small stools. Both cats and dogs suffer from these problems. Colonoscopy requires a fasting period and a stay in the hospital for “clean out” of the colon. In dogs this is accomplished by administration of the human product – Golytely. In cats, multiple enemas are used.A light general anesthesia or heavy sedation is required for complete examination of the colon. The pet usually stays in the hospital for at least 24 hours, first for cleanout, then for the procedure. Associated Veterinary Specialists uses a Pentax Videoendoscopy system for this procedure. After examination of the rectum, colon and cecum, multiple biopsies are taken as well as photographs.

Cystoscopy - A cystoscopy is done for several purposes. To diagnose diseases of the urethra and bladder when other methods are inconclusive. To remove calculi from the urethra and bladder via grasping forceps or laser lithotripsy. To cannulate the ureters to facilitate placement of stents for relief of obstruction.A sterile cystoscope, Associated Veterinary Specialists has all the available rigid and flexible cystoscopes, is placed into the urethral opening with the pet under anesthesia and gently guided forward into the bladder. This can be accomplished in female dogs and cats of almost any size but cannot be performed in small male dogs or male cats.

Electrocardiography - EKGs are taken when pets are suspected of having heart disease. Electrocardiography is also used as a monitoring tool for anesthesia.The EKG is used to analyze disturbances of the rhythm of the heart. Various rhythm disturbances, called arrythmias, occur and include disorders that slow down as well as speed up the heart. Symptoms of arrythmias include exercise intolerance, weakness or even fainting. Some arrythmias produce no symptoms.

Electromyography - Electromyograph is used to evaluate diseases of peripheral nerves and muscles. Pets with these disorders often have symptoms of weakness, gait disturbances and muscle atrophy. An EMG is recorded with the pet under anesthesia. Abnormal electrical of the muscles, changes in the speed that a nerve conducts it's impulse or changes in the way the nerve communicates with the muscle can be analyzed and used to diagnose neuromuscular disorders.

Endoscopy - Upper gastrointestinal endoscopy is one of the most common procedures performed at AVS on dogs and cats. And one duck. With the pet under general anesthesia, a long, lighted tube with a video camera on the tip is guided through the mouth, into the esophagus then the stomach and upper small intestine. Photographs are taken, biopsies of the tissues are taken and other procedures are accomplished such as foreign body removal, ballon dilation or feeding tube placement.Common reasons to perform upper gi endoscopy include vomiting or regurgitation, persistent diarrhea, placement of feeding tubes, foreign body removal or evaluation of unexplained intestinal bleeding.

Laparoscopy - Laparoscopy requires general anesthesia for the pet. After the abdomen is prepped, carbon dioxide gas is placed into the abdominal cavity to facilitate examination. Multiple organs can be seen such as the liver, gall bladder, pancreas, spleen, kidneys and bladder. The most common use of laparoscopy at Associated Veterinary Specialist is to obtain diagnostic biopsies from the liver. Post operative discomfort is minimal and laparoscopy is often an outpatient procedure.

Oncology - Both dogs and cats suffer from cancer. Cancer in veterinary medicine is as variable as in human medicine. Cancer can occur in almost any organ of the body in pets and people. The treatment of cancer of animals is similar to that of humans in that surgery, radiation therapy, chemotherapy and immunotherapy are all used. Associated Veterinary Specialists does chemotherapy, immunotherapy and surgery. Pets that need radiation are referred to the University of Missouri at Columbia or the Missou Animal Cancer Care Center in Wentzville, Missouri.

Radioactive iodine therapy - Hyperthyroidism is a common problem of middle aged and older cats. It is a rare disease of dogs although Associated Veterinary Specialists has treated one dog. It is caused by benign tumors of the thyroid called thyroid adenomas. They are rarely malignant. A long delay from the time of diagnosis to the time of radioactive iodine therapy may increase the chance of the tumor becoming malignant.Cats with hyperthyroidism have a variety of symptoms with weight loss being the most common. Most are diagnosed with a simple blood test but some require more sophisticated testing to be certain of the diagnosis. The gold standard of treatment is radioactive iodine therapy. Other therapies are much less desirable and efficacious. Surgery, methimazole therapy and dietary therapy are all available but have serious drawbacks and are very poor substitutes for radioactive iodine. Delay of definitive treatment can often be very detrimental to the cat.Owners will schedule an appointment with one of the internists to be certain of the diagnosis and that radioactive iodine is appropriate for the pet. The pet is evaluated and all of the owner’s questions are answered. Additional tests may be prescribed but not often. The guidelines for care of the cat after therapy are discussed as well as the restrictions necessary since the cat is radioactive after treatment. This is not dangerous to humans or other pets. The guidelines are simple to follow and mostly involve common sense. Ninety-five percent of cats are cured with a single dose. A few cats require thyroid supplementation and a few cats may need a second treatment in the future. There are no short or long term side effects of radioactive iodine other than a few that require supplements because their thyroid levels are too low. Cats having iodine therapy are admitted on Tuesday morning and are released on Thursday. Owners are requested to bring 3 days of their normal diet along so their diet is not changed. They are checked for radioactivity in 2 weeks and they return to the family veterinarian in 4 weeks for a repeat of the thyroid level. After that no further therapy or testing is usually required other than routine monitoring.

Rhinoscopy - Rhinoscopy is most commonly performed after imaging of the nasal cavity with MRI. MRI is critical to localize the disease process. Nasal diseases not only involve the nose but also the sinuses, nasopharynx, often middle ears and sometimes the brain. Imaging is the first step. After imaging is done, various endoscopic equipment is used to look inside the nose and nasopharynx. Foreign bodies can be removed, cultures and biopsies are taken as needed.

Thoracoscopy -

Endoscopic Video Otoscopy - The external ear canal and eardrum can be visualized with a video endoscopy designed for use in the ear. Associated Veterinary Specialists uses a Storz video otoscope to evaluate the ears of dogs and cats. The superior optics and magnification make this the superior method to evaluate the ear canal and eardrum. Pets require sedation or light anesthesia for this procedure. Diseases of the ear such as infections, tumors, rupture of the eardrum and otitis media can be evaluated with this method

Care of Diabetes Mellitus in Dogs and Cats - Pets with diabetes are often referred to an internal medicine specialist for care. Associated Veterinary Specialists employs Dr. Wayne R. Hause, Diplomate, American College of Veterinary Internal Medicine and Dr. Christine G. Cocayne, Diplomate, American College of Veterinary Internal Medicine, as well as Dr. Kimberly A. Loyd who is a resident in internal medicine who care for these patients.

Regulation of diabetes in animals is often challenging. Pets often have underlying health problems that require the expertise of a veterinary specialist. Many pets are simply challenging to regulate. Veterinary internists specialize in this area of veterinary medicine. Associated Veterinary Specialists employs a team approach to these cases. An internist and a veterinary technician will work together to manage the diabetes for each individual patient. After the initial workup and treatment plan, AVS will most commonly recommend that the pet�s blood sugar be monitored with a glucometer manufactured by Abbott Laboratories (www.alphatrakmeter.com). This device is called AlphaTRAK 2 and it is a veterinary specific device calibrated for use in dogs and cats. The calibration is even different for each species. Human glucometers are often not accurate for use in animals and therefore their usage is discouraged. Adjustments in the insulin dosage can be made over the telephone or via email as needed. The internists at AVS feel that admitting veterinary patients to the hospital for glucose monitoring is not as accurate as at home monitoring. This should only be done for patients for whom the client cannot monitor the blood sugar at home.

Diabetic dogs and cats can often live a long healthy life when close attention is paid to their problems and the owners work with the veterinary internists and animal health technicians of AVS. These pets are seen as outpatients 3 or 4 times a year to make sure their individual needs are met and their problems are detected early.

In Missouri, most diabetic products can be obtained without a prescription and it behooves the pet owner to shop around for the best prices on these products. When at AVS for an appointment, make sure you inquire about where to obtain these materials.

Ultrasound - Ultrasound imaging, also known as sonography, is a non-invasive procedure used to evaluate the internal organs. This is most commonly used to image the abdominal organs, such as the liver, spleen, kidneys, gastrointestinal tract and adrenal glands. Ultrasound can also be used to image the heart and other soft tissues such as the parathyroid glands.

How is an ultrasound performed?At Associated Veterinary Specialists, AVS, an ultrasound is a scheduled procedure performed by a board certified internal medicine specialist or a board certified radiology specialist. If your veterinarian recommends that your pet have an abdominal ultrasound or you feel your pet may need an abdominal ultrasound, we may ask that you do not feed your dog or cat the morning of the procedure. Food in the stomach can make visualization of some of the abdominal organs difficult. When you bring your pet to AVS we will take him or her to our treatment area to prepare for and perform the ultrasound. To prepare your pet for the ultrasound, we will shave the hair from the area that is going to be examined. The ultrasound probe needs to have close contact with the skin to produce images so the hair needs to be removed in the area being examined. Next the patient is placed in position for the ultrasound. For an abdominal ultrasound this means they will need to lie on their back. Since the procedure can take 30-45 minutes, we lay them on their back in a padded trough to increase the comfort of lying in this position for an extended amount of time. Warmed ultrasound gel is applied to the shaved area to ensure close contact of the ultrasound probe and skin which improves the resolution of the images. All the organs are evaluated and pictures or videos are obtained as needed. When your pet is done, the doctor will discuss the ultrasound results and show pictures or videos when appropriate.

What are the benefits of ultrasound?Abdominal ultrasound can be used to look at the internal architecture of organs, something that cannot be seen on X-rays. For example, a tumor within the bladder could be seen on ultrasound but would not be able to be seen on X-rays. We can also use the ultrasound to obtain needle aspirates to collect samples of fluid, such as urine, for analysis or samples of tissue, such as the liver or a tumor, for cytology. Biopsies can also be performed with ultrasound guidance to obtain tissue for histopathology. Cardiac ultrasound, also known as echocardiography, can be used to look for structural disease of the heart, such as valvular disease, or heart tumors.

What are the risks of ultrasound?There are no risks to performing the ultrasound itself. Some patients need to be sedated for the procedure and risks of sedating of your pet will be discussed before the procedure.

Why should I have the ultrasound performed at AVS?There are two important aspects to consider when having an ultrasound performed on your pet. First, will the person performing the ultrasound be able to get adequate images? Board certified radiology specialists go through a residency program where they are trained to perform ultrasounds. Other veterinarians, such as internal medicine specialists and general practioners, can attend workshops to learn how to obtain images with the ultrasound. In then end many veterinarians can learn how to perform an ultrasound. The more important consideration is who will to interpret the ultrasound findings and, more specifically, interpret them in relation to your pet’s illness. This is much more difficult. The interpretation of the ultrasound is why it is advantageousto have the ultrasound performed at AVS. At AVS an internal medicine specialist is always involved in the interpretation of your pet’s ultrasound findings. Internal medicine specialists have advanced training and knowledge of the function and disease processes of the various abdominal organs and are best qualified to determine how the ultrasound findings apply to your pet. For this reason, a consult exam with an internal medicine specialist is always part of the ultrasound examination. The ultrasound exam findings and interpretation of these findings are discussed with you and your regular veterinarian. Based on this assessment, an internal medicine specialist will recommend additional testing and/or treatment.

Laser Ablation of Ectopic Ureters - Cystoscopy is the diagnostic method of choice to diagnose and also treat ectopic ureters. The cystocopist identifies the abnormal opening of the ectopic ureter, mostly in the urethra. A guidewire is placed in the ectopic ureter and the scope is withdrawn. A ureteral catheter is placed over the guidewire into the abnormal ureter. The cystoscope is then replaced into the ureter to visualize the catheter in the ectopic ureter. Contrast xrays are made via fluoroscopy to confirm the diagnosis and trace the path of the ectopic ureter. A holmium:YAG laser is used to dissect the wall of the ectopic ureter so its opening is returned to the interior of the bladder thus restoring continence in most cases. This is an outpatient procedure and most cases return home the same day.

Laser Lithotripsy of Bladder and Urethral Stones - Associated Veterinary Specialists uses a Stonelight Holmium:YAG laser to perform laser lithotripsy. This can be used with dogs and some cats to perform a minimally invasive procedure to remove calculi (stones) from the urinary tract. After induction of anesthesia, the cystoscopist visualizes the calculus and passes a laser fiber through the scope until the tip is in contact with the calculus. Pulses of high energy laser light are used to fragment the calculus. The fragments then can be removed with basket forceps or flushed out of the bladder. It is usually and outpatient procedure.Contact any of the AVS internists for more information.

Care of Diabetes Mellitus in Dogs and Cats

Pets with diabetes are often referred to an internal medicine specialist for care. Associated Veterinary Specialists employs Dr. Wayne R. Hause, Diplomate, American College of Veterinary Internal Medicine and Dr. Christine G. Cocayne, Diplomate, American College of Veterinary Internal Medicine, as well as Dr. Kimberly A. Loyd who is a resident in internal medicine who care for these patients.

Regulation of diabetes in animals is often challenging. Pets often have underlying health problems that require the expertise of a veterinary specialist. Many pets are simply challenging to regulate. Veterinary internists specialize in this area of veterinary medicine.

Associated Veterinary Specialists employs a team approach to these cases. An internist and a veterinary technician will work together to manage the diabetes for each individual patient. After the initial workup and treatment plan, AVS will most commonly recommend that the pet's blood sugar be monitored with a glucometer manufactured by Abbott Laboratories (www.alphatrakmeter.com). This device is called AlphaTRAK 2 and it is a veterinary specific device calibrated for use in dogs and cats. The calibration is even different for each species. Human glucometers are often not accurate for use in animals and therefore their usage is discouraged. Adjustments in the insulin dosage can be made over the telephone or via email as needed. The internists at AVS feel that admitting veterinary patients to the hospital for glucose monitoring is not as accurate as at home monitoring. This should only be done for patients for whom the client cannot monitor the blood sugar at home.

Diabetic dogs and cats can often live a long healthy life when close attention is paid to their problems and the owners work with the veterinary internists and animal health technicians of AVS. These pets are seen as outpatients 3 or 4 times a year to make sure their individual needs are met and their problems are detected early.

In Missouri, most diabetic products can be obtained without a prescription and it behooves the pet owner to shop around for the best prices on these products. When at AVS for an appointment, make sure you inquire about where to obtain these materials.

Physical Rehabilitation

Physical therapy has been an important part of the care of human patients with neurologic or musculoskeletal disease. AVS can provide this same standard of care to veterinary patients. Many patients will benefit from a period of physical rehabilitation to achieve an earlier and more complete return to function.

Physical rehabilitation can help decrease pain, increase mobility, flexibility and balance. Rehabilitation can also build strength, muscle mass and endurance, as well as maximize recovery from surgery, injury or disease.